Small cell carcinoma of the prostate - A morphologic and immunohistochemical study of 95 cases
Small cell carcinoma of the prostate - A morphologic and immunohistochemical study of 95 cases
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DOI：
10.1097/pas.0b013e318058a96b
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发表时间：
2008-01-01
影响因子：
5.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
--
作者：
Wang, Wenle;Epstein, Jonathan I.
前列腺小细胞癌是罕见的，文献包括病例报告和小系列。本文对我院确诊的95例前列腺小细胞癌的形态学和免疫组化进行了分析。标本包括55例穿刺活检，27例经尿道切除，4例根治性前列腺切除术，9例转移灶活检（部分患者行>1手术）。患者年龄44 ~ 92岁（平均69岁）。虽然某些病例的血清前列腺特异性抗原（PSA）非常高（高达1896 ng/mL），但中位数仅为4.0 ng/mL。在有资料的病例中，33/78（42%）有常见性前列腺腺癌病史。小细胞癌与既往前列腺癌的诊断间隔为1 ~ 300个月（中位25个月）。单纯小细胞癌占54/95(57%)，其余病例合并前列腺癌。在腺癌中，20.5%的病例在小细胞癌和腺癌之间有明显的界限；在其余情况下，这两个组成部分逐渐合并。混合病例以小细胞癌为主（中位数：80%）；85%的腺癌Gleason评分为bb0.8。61例（64%）小细胞癌为典型的“燕麦细胞”形态，其余为“中间细胞”变异。95例中：坏死占40%（肿瘤的2% ~ 95%）；巨型奇异细胞占19%；印度占21%；莲座形成29%；灶性空泡细胞质占18%；结缔组织增生占20%。大多数（88%）小细胞癌至少1项神经内分泌标志物阳性。在小细胞癌成分中，14/73（19%）的PSA阳性，17/61（28%）的前列腺素（P501S）阳性，15/59（25%）的前列腺特异性膜抗原阳性，尽管通常是局部的。甲状腺转录因子-1染色阳性23/44（52.3%）。在这一最大规模的前列腺小细胞癌研究中，我们强调了可能导致其漏诊的形态学特征。小细胞癌伴玫瑰花结的其他典型组织学特征对其准确诊断至关重要。P501 S和前列腺特异性膜抗原在鉴别小细胞癌的前列腺起源方面优于PSA，尽管大多数（60%）前列腺小细胞癌的3项标志物均为阴性。
Small cell carcinoma of prostate is rare, with the literature consisting of case reports and small series. The current work analyzes the morphology and immunohistochemistry of 95 cases of prostatic small cell carcinoma diagnosed at our institution. Specimens included 55 needle biopsies, 27 transurethral resections, 4 radical prostatectornies, and 9 biopsies from metastatic sites (some patients with > 1 procedure). Patients ranged in age from 44 to 92 years old (mean: 69 y). Although serum prostate-specific antigen (PSA) in some cases was very high (up to 1896 ng/mL), the median value was only 4.0 ng/mL. Of cases with available information, 33/78 (42%) had a history of usual prostatic adenocarcinoma. The interval between the diagnosis of small cell carcinoma and prior usual prostatic cancer ranged from I to 300 months (median 25 mo). Pure small cell carcinoma was seen in 54/95 (57 %) of cases with the remaining cases admixed with prostate adenocarcinoma. In cases with adenocarcinoma, there was a sharp demarcation between small cell carcinoma and adenocarcinoma in 20.5% of cases; in the remaining cases there was gradual merging of the 2 components. In mixed cases, small cell carcinoma predominated (median: 80% of the tumor); the Gleason score of the adenocarcinoma was > 8 in 85% of these cases. In 61 cases (64%), small cell carcinoma was classic "oat cell" morphology with remaining the "intermediate cell" variant. Of the 95 cases: necrosis was seen in 40% (2% to 95% of the tumor); giant bizarre cells in 19%; Indian filing in 21%; rosette formation in 29%; focal vacuolated cytoplasm in 18%; and desmoplasia in 20%. Most (88%) of small cell carcinoma were positive for at least I neuroendocrine marker. In the small cell carcinoma component, 14/73 (19%) were positive for PSA, 17/61 (28%) positive for prostein (P501S), and 15/59 (25%) positive for prostate-specific membrane antigen, although often very focally. Stains for thyroid transcription factor-1 were positive in 23/44 (52.3%) cases. In this, the largest study of prostatic small cell carcinoma, we highlight the presence of morphologic features that may result in its underdiagnosis. Other more classic histologic features of small cell carcinoma along with rosettes are critical for its accurate diagnosis. P501 S and prostate-specific membrane antigen were better in identifying the prostatic origin of small cell carcinoma than PSA, although the majority (60%) of prostatic small cell carcinomas were negative for all 3 markers.